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MALTREATMENT INVESTIGATION MEMORANDUM Minnesota Statutes, section 260E.01, paragraph (a), “The legislature hereby declares that the public policy of this state is to protect children whose health or welfare may be jeopardized through maltreatment.”
License Number and Program Type: 1023991-CCC (Child Care Center) Investigator(s): Tessa Ripka 651-431-6612 Suspected Maltreatment Reported: Allegation One: It was reported that when a group of children went outside to play a staff person (SP1) did not have control of the children and one child (AV1) ran out into the parking lot in front of a moving vehicle. Allegation Two: It was reported that a staff person (SP2) dropped a child (AV2) when attempting to place AV2 into a Bumboo chair. Allegation Three: It was reported that a child (AV3) rolled off a changing table and landed on the floor when SP1 failed to keep his/her hand on AV3. Date of Incident(s): September 2024 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 260E.03, subdivision 15, paragraph (a), clauses (1) and (2): Failure by a person responsible for a child's care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child's physical or mental health when reasonably able to do so. Failure to protect a child from conditions or actions that seriously endanger the child's physical or mental health when reasonably able to do so. Summary of Findings: Pertinent information was obtained during a site visit conducted on October 28, 2024; from documentation at the facility; and through ten interviews conducted with seven facility staff persons (SP1, SP2, P1, P2, P3, P4, P5), AV1’s family member (FM1), AV2’s family member (FM2), and AV3’s family member (AV3). Due to their ages AV1, AV2, and AV3 were not able to provide information about the incidents. Facility documentation showed that all staff persons interviewed were trained on the facilities policies, the Risk Reduction Plan for Licensed Child Care Centers, and the Reporting of Maltreatment of Minors Act. Allegation One: It was reported that when a group of children went outside to play SP1 did not have control of the children and AV1 ran out into the parking lot in front of a moving vehicle. The facility was located in a large building with eight classrooms. Outside the front entrance was a parking lot. Down a sidewalk and across a non-public road were two fenced in playgrounds (toddler playground and preschool playground). There was a cross walk with road cones that went from the sidewalk across the non-public road to the playground area. The playground area bordered the side of the parking lot and had a small area of grass in between. AV1 was 31 months old at the time of the incident and enrolled in a toddler classroom. P1, P2, P5, and written documentation provided the following information: · On September 20, 2024, at approximately 3:50-4:15 p.m., P1 was on the toddler playground with seven children. P2 had been in the preschool playground but was leaving for the day and getting ready to go back into the building. SP1 came outside with his/her classroom of six or seven children. SP1 was holding two children’s hands, and the rest of the group was ahead of SP1. · As the classroom crossed the area with road cones, AV1 started to run ahead toward the playground and a couple other children followed AV1. P2 started to go toward AV1. SP1 continued with the other children toward the playground. SP1 did not react or respond to the children running from the group. · AV1 stepped out onto the paved parking lot next to the playground as a vehicle was turning into the parking lot. The vehicle appeared to see AV1 and slowed to a stop approximately 4 yards from AV1. AV1 got approximately two to three feet into the parking lot before P1 stepped out of the playground gate and brought AV1 from the parking lot to the playground. · P2 grabbed the two other children that were near the curb to the parking lot and brought them into the playground. SP1 continued to the toddler playground with the rest of his/her children. · Staff persons were to use a walking rope with the children when going outside. In the past SP1 had not used the walking rope and sometimes did not interact with the children when on the playground. SP1 provided the following information: · On the date of the incident, after snack time, SP1 took his/her classroom of seven children outside but “forgot” the facility policy to use a walking rope. SP1 walked with the group outside to the crosswalk area when AV1 ran ahead toward the playground and two other children started to follow. · SP1 called to AV1 but SP1 was not sure if AV1 heard SP1. P1 and P2 were also in the playground area and were calling to AV1 and telling AV1 to stay with SP1. AV1 stepped out into the parking lot. There was a vehicle in the parking lot that saw AV1 and stopped. AV1 walked back to the grass area and to the playground fence. FM1 had no prior concerns. The Risk Reduction Plan for Licensed Child Care Centers stated that children played in a fenced in playground and were always supervised. Children were never allowed to go on the road or parking lot without adult supervision. Conclusion for Allegation One: Information was consistent that on the date of the incident, SP1 came outside with his/her classroom and crossed the crosswalk toward the playground. AV1 ran ahead of the group and out into the parking lot. A vehicle coming into the parking lot stopped and P1 was able to step out of the toddler playground to get AV1 back onto the grass area while SP1 continued down to the playground with the rest of his/her classroom. Although AV1 stepped out into the parking lot, given that AV1 was within hearing and sight of SP1, P1, and P2 and that P1 and P2 immediately intervened when they saw AV1 running toward the parking lot, there was not a preponderance of the evidence that there was a failure to protect AV1 from conditions or actions that seriously endanger AV1’s physical health. It was determined that neglect did not occur (Failure by a person responsible for a child's care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child's physical or mental health when reasonably able to do so. Failure to protect a child from conditions or actions that seriously endanger the child's physical or mental health when reasonably able to do so.) Allegation Two: It was reported that SP2 dropped AV2 when attempting to place AV2 into a Bumboo chair. AV2 was six months old at the time of the incident and enrolled in an infant classroom. An Accident/Incident Report showed that on September 11, 2024, at 12:45 p.m., AV2 was getting into a booster seat and fell face first. AV2 was held while the fall happened, and it was a “soft fall.” AV2 was checked for marks and bumps and no medical attention was required. P3 said that on the date of the incident, P3 was in the infant classroom with SP2. P3 was rocking a baby to sleep and saw SP2 start to put AV2 into a Bumboo seat (soft foam floor seat). The Bumboo seat was sitting on a carpeted area in the classroom. SP2 was squatting with his/her back to the seat and holding AV2 by the torso. SP2 attempted to put AV2 into the chair when SP2 dropped AV2 and AV2 fell to the ground onto his/her stomach. AV2 was dropped less than a foot and was not injured. AV2 cried so SP2 picked up AV2 and s/he calmed down “pretty quick.” SP2 had some “wrist issues” and it appeared that SP2 lost his/her grip on AV2. FM2 was notified of the incident later that day. P5 had no previous concerns with SP2. SP2 provided the following information: · On the date of the incident, SP2 was in the classroom to cover another staff person’s lunch break. AV2 was crying so SP2 picked up AV2 and comforted him/her. AV2 calmed down and SP2 walked AV2 to the “car seat area” carrying AV2 on SP2’s hip. Once in the area, SP2 shifted AV2 from SP2’s hip to SP2’s front holding AV2 with AV2’s legs on either side of SP2’s waist. · SP2 then squatted down and started to put AV2 in a Bumboo seat. AV2 started crying and started to curl his/her body forward. Since SP2 was squatting this threw his/her balance off and s/he started to tip forward. · SP2 “guided” AV2 to the floor on his/her stomach and SP2 moved him/herself over the top of AV2. AV2’s legs were almost touching the ground and when s/he went forward, SP2 was holding onto AV2 the whole time. · The fall was not a “free fall” and SP2 had his/her hands on AV2 the whole time. SP2 checked AV2 over for injuries and did not find any. AV2 was placed in the Bumboo chair and SP2 left the classroom shortly after. FM2 said s/he was informed of the incident when it occurred and was told it would not happen again. Conclusion for Allegation Two: Information was consistent that on September 11, 2024, SP2 squatted down and attempted to put AV2 into a Bumboo seat. SP2 lost his/her balance causing AV2 to fall and land on his/her stomach on the floor. P3 said that AV2 fell less than a foot. SP2 said that it was not a “free fall” and SP2 had his/her hands on AV2 the whole time. AV2 cried but did not appear to be injured. Although AV2 fell while SP2 attempted to put AV2 into a Bumboo chair, given that AV2 was not injured and that the fall was low to the ground and a result of the SP2 losing his/her grip, there was not a preponderance of the evidence that SP2 failed to protect AV2 from conditions or actions that seriously endangered AV2’s physical health. It was determined that neglect did not occur (Failure by a person responsible for a child's care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child's physical or mental health when reasonably able to do so. Failure to protect a child from conditions or actions that seriously endanger the child's physical or mental health when reasonably able to do so.) Allegation Three: It was reported that AV3 rolled off a changing table and landed on the floor when SP1 failed to keep his/her hand on AV3. The infant classroom was a large open room with a small area of tiled floor to the left. There were cabinets and counters along two sides of the corner. In the corner on the counter was a changing pad. There were upper cabinets to the right of the changing pad. Approximately four feet off the counters the flooring changed to carpeting and there was an area with shelving and toys. On the right side of the room was a crib area that contained cribs. AV3 was 9 months old at the time of the incident and enrolled in the infant classroom. P3, P4, and P5 provided the following information: · P4 did not remember the date of the incident but thought it occurred on a Monday at approximately 12-12:30 p.m. On that day P4 and SP1 worked in the infant room and were filling in for other staff persons that were on break. · SP1 had AV3 on the changing table and P4 stood nearby to the left of SP1. SP1 went to grab the supplies to change the diaper and did not have his/her hands on AV3. The supplies were located in an upper cupboard which could be reached from the changing table. SP1 still stood in front of AV3 and SP1’s body did not move but s/he took his/her hands off AV3. · AV3 rolled off the changing table in between SP1 and the counter and landed on his/her hands and knees. AV3 started to cry “really hard.” SP1 hesitated for a second and then picked up AV3 and calmed AV3 down. After approximately five to ten minutes AV3 calmed down. SP1 changed AV3’s diaper and put AV3 on the ground. · SP1 checked AV3 for injuries. AV3 did not seem to be injured and was playing and acting “fine.” SP1 asked if s/he should fill out a “form” and P4 told SP1 that s/he should fill out a form. P4 told P5 and/or another supervisory staff person about what happened. · P3 was working in the classroom on the date of the incident, but was not in the classroom when the incident occurred. P3 heard about the incident later in the day. P3 did not notice any injury or any other concerns with AV3. · When staff persons changed diapers, they were to have all supplies ready and have one hand on the child at all times. SP1 had been previously trained in the infant classroom. SP1 provided the following information: · On the day of the incident (SP1 could not recall the date) at approximately 10 or 11 a.m., s/he was supposed to change AV3’s diaper. SP1 had only been in the infant classroom on two or three occasions and was not aware of where the supplies were kept. · AV3 was on the changing pad when SP1 took his/her hand off to reach for some supplies. AV3 wiggled and fell off the counter. As AV3 fell, s/he fell into SP1’s leg so AV3 did not hit the floor as hard. SP1 was not sure how AV3 landed but thought s/he landed on his/her butt or back. AV3 started crying and SP1 picked up AV3 and checked him/her over for injuries while s/he changed AV3’s diaper. · SP1 asked if s/he should report the incident and P4 was not sure. SP1 said s/he should have told a supervisory staff person. P5 said that s/he was unaware of the incident. FM3 was not aware of the incident and was surprised s/he had not been notified. FM3 had no prior concerns. The Diapering Procedure stated that when changing diapers, staff persons were to first organize needed supplies within reach, cover diaper surface, and put gloves on. The staff person then was to put the child on the diaper surface, remove the soiled diaper, clean the diaper area, and diaper and then dress the child. Staff persons were to keep one hand on the child the entire time. The Risk Reduction Plan for Licensed Child Care Centers stated that one hand remained on a child being changed at all times. Conclusion for Allegation Three: Information was consistent that on the day of the incident, SP1 and P4 worked in the infant classroom. SP1 put AV3 on the changing pad on the counter to change his/her diaper. SP1 took his/her hands off AV3 to grab changing supplies and AV3 rolled off the counter onto the floor. AV3 cried but did not appear to be injured. Minnesota Statutes, section 260E. 30, subdivision 3 states that rather than making a determination of substantiated maltreatment by an individual, the commissioner of human services shall determine that a nonmaltreatment mistake was made by the individual. A nonmaltreatment mistake occurs when: (1) at the time of the incident, the individual was performing duties identified in the center's child care program plan required under Minnesota Rules, part 9503.0045; (2) the individual has not been determined responsible for a similar incident that resulted in a finding of maltreatment for at least seven years; (3) the individual has not been determined to have committed a similar nonmaltreatment mistake under this paragraph for at least four years; (4) any injury to a child resulting from the incident, if treated, is treated only with remedies that are available over the counter, whether ordered by a medical professional or not; and (5) except for the period when the incident occurred, the facility and the individual providing services were both in compliance with all licensing requirements relevant to the incident. Consistent information was provided that SP1 was near AV3 but reached for supplies, causing SP1 to take his/her hands off AV3. SP1’s actions or conduct were determined to be a nonmaltreatment mistake for the following reasons: (1) At the time of the incident, SP1 was performing job related duties, as require by the facility’s policies; (2) SP1 had not been determined responsible for any previous incident that resulted in a finding of maltreatment; (3) SP1 had not been previously determined to have committed a nonmaltreatment mistake under this paragraph; (4) AV3 was not visibly injured and did not require any medical treatment; and (5) Except for the period when the incident occurred, the facility and SP1 were in compliance with all licensing requirements relevant to the incident. The nonmaltreatment mistake to AV3 by SP1 was not maltreatment. It was determined that neglect did not occur (Failure by a person responsible for a child's care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child's physical or mental health when reasonably able to do so. Failure to protect a child from conditions or actions that seriously endanger the child's physical or mental health when reasonably able to do so.) Pursuant to Minnesota Statutes, section 260E.35, subdivision 6, paragraph (b), the investigative data in this report will be maintained by the Department of Human Services for a period of five years. Action Taken by Facility: The facility completed an internal review and determined that policies and procedures were adequate but not followed by SP1. SP1 completed more training in each classroom. Action Taken by Department of Human Services, Office of Inspector General: SP1 was not determined as a perpetrator of maltreatment of AV3 because the Department of Human Services found that the incident for which SP1 was responsible met the criteria to be determined a nonmaltreatment mistake. SP1 was notified by the Office of Inspector General that any future incident of possible neglect of an alleged victim for which SP1 is responsible might not be considered a nonmaltreatment mistake. Certification: The information collection procedures followed in this investigation were pursuant to Minnesota Statutes, section 260E.30, subdivision 6, paragraph (c). All individuals that are subjects of data in this investigation have the right to obtain private data on themselves which was collected, created, or maintained by the Department of Human Services.
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